Middletown, Ohio, a city under siege: ‘Everyone I know is on heroin’

The opioid epidemic is a national crisis. But what does that mean? To answer that, Yahoo News traveled to Middletown, Ohio — a city once considered as ordinary as its name, more recently known for an explosion in opioid use — and explored quantitative research about drugs, health care, and national public opinion. This is a problem so serious that it requires big data, so human that it needs a face. Here is what we found:

Jack Barrett, a recovering heroin addict, attends group therapy at Groups in Middletown, Ohio. He credits this treatment center with saving his life. (Photograph by Mary F. Calvert for Yahoo News)

For 16 of his 36 years, Jack Barrett has been a heroin addict. Today, he sits casually in a white plastic chair at Groups, the treatment center that he credits with saving his life. That was after he finally sought help for the first time — after overdosing, and being revived with Narcan, eight times in seven days. He says that the problem was fentanyl, a synthetic opioid some 40 times more potent than heroin: “It’s not just heroin anymore.” How did he start using? “How does anyone start? I don’t know.” It’s his first time getting help that sticks in his memory.

Groups lies off Main Street and Central Avenue in Middletown, Ohio — a city of 49,000 that the Butler County prosecutor calls the “buckle of Middle America,” the Butler County sheriff calls “the Heartland” and many people here seem to call “home, unfortunately.” Far from making him stand out, in Middletown Jack’s addiction signifies his belonging. “If you’re young here,” he explains, “people just assume you’re on heroin.”

Between 1999 and 2014, American overdose deaths involving opioids nearly quadrupled to 28,647 — much of the increase driven by synthetic opioids such as fentanyl. In 2015, the toll exceeded 33,000. In few places is the magnitude and the pervasiveness of the crisis more apparent than in Middletown, Ohio. Yet the epidemic here is not unique: Ohio’s opioid deaths per capita are the third, not the first, highest in the country, after West Virginia and New Hampshire; Butler County’s the third highest in the state. In 1957, the National Civic League named Middletown an “all-American city.” Today, Middletown is the microcosm of an American epidemic that threatens to make addiction, crime and poverty a national norm. The city offers a lesson in the speed and power with which addiction can sabotage a community. And while we can glean possible answers in Middletown, we also see the high odds against success.

“Everyone I know is on heroin,” says a hunched, fidgeting mother of three, running her hand through dry hair that was once blond. She is waiting for the free breakfast offered by a local church. She goes to a methadone clinic three times a week. Her next-door neighbors have lost two kids to overdoses since May.

“It’s not an epidemic. It’s a pandemic,” warns a recovering addict one table over, his eyes wide.

According to local lore, Middletown derives its name from its position halfway between Dayton and Cincinnati. That geography now intensifies the opioid epidemic: As Gene Robinson, clean for most of the past 18 months, puts it, “Middletown is stuck in between two major cities. Dayton is the drug capital of Ohio. It’s easy access. And there’s not a lot of work in town.”

In her living room half a mile from downtown Middletown, Robinson’s fiancée, Terri Fugate, gets straight to the point: “This here is a town full of addicts.” She talks about prostitutes patrolling the streets; a young girl left for dead in a boarded-up house down the street; a man who overdosed while driving a gas truck. Her son Larry started using heroin when he was 19, at his older sister’s house. He had just broken up with his girlfriend. His sister asked if he wanted to sit around moping all day or get high. She shot him up herself.

Larry Fugate, left, a recovering heroin addict at home in Middletown, Ohio. Five months ago, his mom Terri Fugate resuscitated him after a heroin overdose. His mother sits with her fiancé, Gene Robinson, also a recovering heroin addict. (Photograph by Mary F. Calvert for Yahoo News)

Five months ago, Terri found her son overdosed and blue in his room. She administered CPR. “I had to literally bring my baby back. It was the most scariest thing in the world.” Larry was convicted shortly after that for forging a check. (“It had worked a couple times before,” he says. “I knew I would get in trouble for it eventually.”) He got out two days early because he opted to go on the Vivitrol shot — a monthly injection that blocks opioid receptors in the brain. The two days didn’t really matter to him: “I just wanted the Vivitrol.” Larry explains that a week before going to jail, he decided he was done “chasing it. I woke up one morning and was like, I’m not buying dope today.” He says heroin was just too much money. His mother says he had hit his rock bottom.

Gene, Terri’s square-jawed, handsome fiancé, sits on the couch in a neat yellow polo. Gene turned to heroin in 2009 after finding his then-wife dead of a painkiller overdose. He tried to go on Vivitrol once, but it didn’t work. You have to be clean for a week before starting, and that was too much: “It’s good for people who haven’t been on drugs for that long. But I can’t do that.” Now, Terri makes sure that he takes his Suboxone — a prescription medication that relieves opiate withdrawal symptoms. He’s been on and off it for a year and a half. He’s an electrician, but with his record he has to stick to side jobs. The calendar in the kitchen room comes from Access Counseling Services: Terri’s birthday and the dog wash punctuate doctor’s appointments and treatment sessions.

Terri is proud of her boys, Larry and Gene. Larry writes music — a cross between spoken word and rap. He promises, in his latest lyrics, to repay his mother’s efforts. “I picked up the mic,” he sings, “and put the drugs down.”

“I bawled,” Terri says. She has cervical and lung cancer. “It’s crazy. Saying that while I smoke. I guess everyone has their s***.” Terri is a recovering alcoholic. Her sister is in treatment for a heroin addiction. The sister’s boyfriend talks about kicking his coke habit, and about his brother who’s on meth.

The laundry room overflows with stacks of clothes that Terri pulled out the day before for the homeless shelter down the street. They almost obscure the glass bureau filled with neat hardcovers: Catherine Coulter, Mary Higgins Clark, Nelson DeMille. Terri has read most of them but wants to get back to reading. Living Clean: The Journey Continues sits on the living room table. The smell of stale smoke lingers everywhere, clinging to the doilies and embroidered pillows. It defines this house in the same way that addiction defines this loving family — and, with them, Middletown.

Jack tells everyone he knows to go to Groups. “This place is a lifesaver.” He plasters fliers around his neighborhood. He took his brother here for one session, but it didn’t stick. “He wasn’t ready. You need to want help,” explains Jack. He continues to live with his brother, who still uses.

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Emily de La Bruyère has written for the Wall Street Journal, the New York Times, the Huffington Post, and the Daily Beast. She is a student at Sciences Po in Paris on the Michel David-Weill fellowship.